- Eleven new radiotherapy networks to be operating by April, each with a lead provider
- NHS England says new radiotherapy service specifications “may be very challenging”
- Royal College of Radiologists warns networks will “be impossible to realise without strategic funding”
Consolidation of radiotherapy services “will be impossible” without more money, a royal college has warned.
The Royal College of Radiologists said the benefits NHS England hopes to achieve by reorganising services into 11 regional networks from April will require “strategic funding”.
The reorganisation is intended to link-up cancer centres and led to “substantially improved outcomes, including higher cure rates”. NHS England published the service specification this month.
The members of each network have already been agreed and the document said each will have a single lead provider that will be “contractually accountable to NHS England” for delivering the new service specification.
It is understood the lead provider will be chosen through mutual agreement within the network and not through a competitive tender process.
Although NHS England said each lead will be in place by February, HSJ was told there are concerns among trusts that the networks will struggle to meet this deadline.
Due to the financial risks and governance involved in taking on the contract, the larger providers in each network are likely to be awarded the role but it is unclear what happens if trusts cannot agree. Each network will also have to elect a chair.
The tight timeline for implementation comes after NHS England took a year to publish the service specification after an earlier consultation on it closed.
Significant concerns have also been raised about how the reconfiguration will be funded.
In its response to a consultation on the new arrangements, NHS England said:”[It has] committed to providing additional resources over a three-year period to support networks to establish.” It is not clear how much this funding will be but NHSE said it will be “tied to the delivery” of agreed regional yearly plans, which are due to be published in June.
There are also major concerns about how new IT systems, which will be needed to help link up the regional networks, will be paid for.
Jeanette Dickson, RCR vice-president of clinical oncology, said: “Better IT underpins everything needed for the networks to operate but no clear funding has been earmarked. Cancer centres are charged with delivering workforce and IT solutions themselves, which we know, with all the constraints on hospital finances and existing staff shortages, is going to be next to impossible for them to do.
“It is dangerous to assume improved connectivity can occur without centralised investment, or that local workforce solutions can be achieved without a significant boost to the number of oncologists, radiographers and medical physicists who deliver the treatment.”
NHS England said in its consultation response: “It is acknowledged that, in some areas, networks may need to invest in IT infrastructure to reap all the benefits of greater partnership working. NHS England is committed to supporting networks [to] achieve this.”
New service demands
The new service specification said each network must implement out of hours arrangements for people requiring urgent treatment, replace equipment once it is 10 years old and ensure at least 9,000 attendances per year at each provider.
Three additional requirements around the number of cases each oncologist and/or provider must handle every year have also been included in the service specification. The document said these “may take time to fulfil and may be very challenging to meet in geographically remote areas.
“It is recognised that it is important to strike the right balance between supporting local access for service users and ensuring access to specialist expertise.”
Although the networks will be “formally established and operational” by April 2019, NHS England said they will be given “two to three years” to meet the service specification.
NHS England commissions all radiotherapy activity in England as part of its specialised commissioning programme.
The table below lists the trusts involved in each network and the cancer alliances that have been assigned to each network.
|Trusts involved in each network||Cancer alliance/s assigned to network|
|Brighton and Sussex University Hospitals Trust||Surrey and Sussex|
|Imperial College Healthcare Trust||North West and South West London|
|Royal Surrey County Hospital Foundation Trust|
|The Royal Marsden Foundation Trust|
|Barking, Havering and Redbridge University Hospitals Trust||North Central and North East London|
|Barts Health Trust|
|East and North Hertfordshire Trust|
|North Middlesex University Hospital Trust|
|Royal Free London Foundation Trust|
|University College London Hospitals Foundation Trust|
|Guy’s and St Thomas’ Foundation Trust||South East London|
|Maidstone and Tunbridge Wells Trust||Kent and Medway|
|Gloucestershire Hospitals Foundation Trust||Peninsula|
|Plymouth Hospitals Trust||Somerset, Wiltshire, Avon and Gloucestershire|
|Royal Devon and Exeter Foundation Trust|
|Royal United Hospitals Bath Foundation Trust|
|Royal Cornwall Hospitals Trust|
|Taunton and Somerset Foundation Trust|
|Torbay and South Devon Foundation Trust|
|University Hospitals Bristol Foundation Trust|
|Hampshire Hospitals Foundation Trust||Thames Valley|
|Oxford University Hospitals Foundation Trust||Wessex|
|Royal Berkshire Foundation Trust|
|Poole Hospital Foundation Trust|
|Portsmouth Hospitals Trust University Hospital|
|Southampton Foundation Trust|
|Cambridge University Hospitals Foundation Trust||East of England|
|North West Anglia Trust|
|Colchester Hospital University Foundation Trust|
|Ipswich Hospital Trust|
|Norfolk and Norwich University Hospitals Foundation Trust|
|Southend University Hospital NHS Foundation Trust|
|Derby Teaching Hospitals Foundation Trust||East Midlands|
|Northampton General Hospital Trust|
|Nottingham University Hospitals Trust|
|United Lincolnshire Hospitals Trust|
|University Hospitals of Leicester Trust|
|Royal Wolverhampton Hospitals Trust||West Midlands|
|Shrewsbury and Telford Hospital Trust|
|University Hospitals Birmingham Foundation Trust|
|University Hospitals Coventry and Warwickshire Trust|
|University Hospitals of North Midlands Trust|
|Worcestershire Acute Hospitals Trust|
|Lancashire Teaching Hospitals Foundation Trust||Lancashire and South Cumbria|
|The Christie Foundation Trust||Greater Manchester|
|The Clatterbridge Cancer Centre Foundation Trust||Cheshire and Merseyside|
|Hull and East Yorkshire Hospitals Trust||Humber, Coast and Vale|
|Leeds Teaching Hospitals Trust||West Yorkshire|
|Sheffield Teaching Hospitals Foundation Trust||South Yorkshire, Bassetlaw, North Derbyshire and Hardwick|
|North Cumbria University Hospitals Trust||North East and Cumbria|
|South Tees Hospitals Foundation Trust|
|The Newcastle Upon Tyne Hospitals Foundation Trust|
NHS England consultation response, NHS England service specification; Royal College of Radiologists statement
- BARKING, HAVERING AND REDBRIDGE HOSP NHS TRUST
- BRIGHTON AND SUSSEX UNIVERSITY HOSPITALS NHS TRUST
- CAMBRIDGE UNIVERSITY HOSPITALS NHS FOUNDATION TRUST
- Cancer waiting times
- COLCHESTER HOSPITAL UNIVERSITY NHS FOUNDATION TRUST
- DERBYSHIRE HEALTHCARE FT
- EAST AND NORTH HERTFORDSHIRE NHS TRUST
- Finance and efficiency
- GLOUCESTERSHIRE HOSPITALS NHS FOUNDATION TRUST
- GUY'S AND ST THOMAS' NHS FOUNDATION TRUST
- HAMPSHIRE HOSPITALS NHS FOUNDATION TRUST
- HULL AND EAST YORKSHIRE HOSPITALS NHS TRUST
- IMPERIAL COLLEGE HEALTHCARE NHS TRUST
- IPSWICH HOSPITAL NHS TRUST
- LANCASHIRE TEACHING HOSPITALS NHS FT
- LEEDS TEACHING HOSPITALS NHS TRUST
- MAIDSTONE AND TUNBRIDGE WELLS NHS TRUST
- NHS England (Commissioning Board)
- NORFOLK AND NORWICH UNIVERSITY HOSPITAL NHS TRUST
- NORTH CUMBRIA ACUTE HOSPITALS NHS TRUST
- NORTH MIDDLESEX UNIVERSITY HOSPITAL NHS TRUST
- NORTH WEST ANGLIA
- NORTHAMPTON GENERAL HOSPITAL NHS TRUST
- NOTTINGHAM UNIVERSITY HOSPITALS NHS TRUST
- OXFORD UNIVERSITY HOSPITALS NHS TRUST
- Patient experience
- PLYMOUTH HOSPITALS NHS TRUST
- Policy and regulation
- POOLE HOSPITAL NHS FOUNDATION TRUST
- ROYAL BERKSHIRE NHS FOUNDATION TRUST
- ROYAL CORNWALL HOSPITALS NHS TRUST
- ROYAL DEVON AND EXETER NHS FOUNDATION TRUST
- ROYAL FREE LONDON FOUNDATION TRUST
- ROYAL SURREY COUNTY HOSPITAL NHS TRUST
- ROYAL UNITED HOSPITAL BATH NHS FOUNDATION TRUST
- SHEFFIELD TEACHING HOSPITALS NHS FOUNDATION TRUST
- SHREWSBURY AND TELFORD HOSPITAL NHS TRUST
- SOUTHEND UNIVERSITY HOSPITAL NHS FOUNDATION TRUST
- Specialised commissioning
- Specialist care
- TAUNTON AND SOMERSET NHS FOUNDATION TRUST
- Technology and innovation
- THE CHRISTIE HOSPITAL NHS FOUNDATION TRUST
- THE CLATTERBRIDGE CANCER CENTRE NHS FOUNDATION TRUST
- THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST
- THE ROYAL MARSDEN NHS FOUNDATION TRUST
- THE ROYAL WOLVERHAMPTON HOSPITAL NHS TRUST
- Torbay and South Devon NHS Foundation Trust
- UNITED LINCOLNSHIRE HOSPITALS NHS TRUST
- UNIVERSITY COLLEGE LONDON HOSPITALS NHS FOUNDATION TRUST
- UNIVERSITY HOSPITAL SOUTHAMPTON NHS FOUNDATION TRUST
- UNIVERSITY HOSPITALS BIRMINGHAM NHS FOUNDATION TRUST
- UNIVERSITY HOSPITALS BRISTOL NHS TRUST
- UNIVERSITY HOSPITALS COVENTRY AND WARWICKSHIRE NHS TRUST
- UNIVERSITY HOSPITALS OF LEICESTER NHS TRUST
- UNIVERSITY HOSPITALS OF NORTH MIDLANDS NHS TRUST
- WORCESTERSHIRE ACUTE HOSPITALS NHS TRUST